Payment Methodology definition
Examples of Payment Methodology in a sentence
The Contractor submissions to EOHHS for “Alternative Payment Methodology Reporting Template for Managed Care Organizations” will be done in accordance with timeline on Reporting Calendar.
If EOHHS has approved an Alternative Payment Methodology (APM) for the Contractor, EOHS shall apply an adjustment to the Contractor’s repriced paid claims comparable to the APM adjustment that EOHHS used with respect to the Contractor during Capitation Rate development for the Contract Year.
Such demonstration will be based on the annual submission of the “Alternative Payment Methodology Reporting Template for Managed Care Organizations” (included as ATTACHMENT D to Transitioning to Alternative Payment Methodologies: Requirements for Medicaid Managed Care Partners) and EOHHS review of the submitted report.
EOHHS will consider the withhold, for the prorated period of July 1, 2018 through December 31, 2018, as earned due to the Contractor’s efforts in advancing the development of APMs. The withheld amounts will be repaid as quarterly adjusting payments subject to the Contractor’s demonstration that it has achieved the threshold values in APM payments for the reporting period as set forth in Section ▇.▇▇.▇▇.▇▇.▇▇ (Alternative Payment Methodology for Each Contract Period).
To replace Attachment E, Payment Methodology, with a new Attachment E that includes the state fiscal year (SFY) 2016 PMHP rates for the Contractor that CMS just approved.
Such demonstration will be on the basis of quarterly submissions of the “Alternative Payment Methodology Reporting Template for Managed Care Organizations” (included as ATTACHMENT D to Transitioning to Alternative Payment Methodologies: Requirements for Medicaid Managed Care Partners and EOHHS review of the submitted report.
If the Contractor has sub-capitated or Alternative Payment Methodology (APM) arrangements with providers, the sub-capitated or APM payments to providers should be increased by the equivalent of the rate increases that would be required for fee for service payments as set forth in this section.
An Alternative Payment Methodology means a payment methodology structured such that it provides economic incentives, rather than focusing on volume of services provided, focus upon such key areas as: • Improving quality of care; • Improving population health; • Impacting cost of care and/or cost of care growth; • Improving patient experience and engagement; and • Improving access to care.
As part of this support, the Contractor shall work with PCMPs to ensure readiness for the Primary Care Alternative Payment Methodology (APM).
Likewise, if KYOne HP has a Shared Loss Payment Obligation under an applicable Program Agreement, KYOne HP will satisfy the obligation in accordance with the Shared Loss Payment Methodology for the applicable Program Agreement adopted upon Board of Managers Approval in accordance with the KYOne HP Operating Agreement.